- 下颈椎牵张屈曲型损伤手术入路的选择及疗效分析
- 作者:蔡卫华|发布时间:2010-08-18|浏览量:434次
【摘要】 目的 回顾性分析不同手术入路治疗下颈椎牵张屈曲型损伤的疗效。方法 回顾自2002年8月至2008年8月手术治疗的下颈椎牵张屈曲型损伤30例,根据不同类型、是否合并椎间盘损伤和术前牵引复位情况选择不同的手术方法。前路手术7例;后路手术5例;后路+前路手术11例;前路+后路+前路手术7例。分析相关指标:损伤节段Cobb 角及椎体水平移位的变化、神经功能恢复(Frankel 评分)、融合时间、融合率、手术时间以及并发症情况。结果 术后平均随访8个月(5~24个月),所有病例均获得骨性愈合,无内植物松动发生。Frankel 评分术前平均为1.67 分,术后平均2.22分。术前Cobb 角平均为7.78°,术后1.79°,水平位移术前平均3.67 mm ,术后恢复到0.53 mm。前后联合入路手术时间上较单纯前路或后路有明显差异,但在融合时间、Cobb 角、椎体水平移位、融合率和神经功能恢复、并发症等方面无明显统计学差异。结论 根据不同损伤情况选择不同手术入路治疗下颈椎牵张屈曲型损伤均可取得满意的疗效。手术入路的选择应根据关节突脱位、是否可以复位以及椎间盘损伤等情况综合考虑。江苏省人民医院脊柱外科蔡卫华
【关键词】 颈椎;牵张屈曲型损伤;手术治疗;前路手术;后路手术
Analysis of the choice of surgical approach and clinical results of distraction-flexion injury in the lower cervical spine. //CAI Wei-hua, ZHANG ning, LIU Yong-ming, HU Zhi-yi, YIN Guo-yong, CAO Xiao-jian,JIN Zheng-shuai . Department of Orthopaedics , The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China.
[Abstract] Objective To retrospective analysis of different surgical approach and its clinical results on the treatment of distraction-flexion injury in the lower cervical spine. Methods From Aug 2002 to Aug 2008, 30 cases with a distraction-flexion injury of the lower cervical spine were treated surgically. Seven cases were treated with anterior approach alone , 5 with posterior approach alone , 11 with posterior combined anterior approach and 7 were treated with a combined anterior - posterior - anterior approach. The following parameters were analyzed: the change of transverse displacement and Cobb’s angle, neurologic recovery(Frankel criteria),fusion time, fusion rate, surgery time, and the rate of complications. Results The mean following time was 8 months(5~24 m). Bone fusion reached in all patients. No plate and screw loosening occurred. The Frankel score increased from 1.67 preoperatively to 2.22 postoperatively. The Cobb’s angle was 7.78°before operation and 1.79°after operation , the transverse displacement was 3.67 mm before operation and 0.53 mm after operation. Combined anterior and posterior approach had a significantly longer mean operation time than anterior approach alone. There were no significant differences in the changes in fusion time, transverse displacement and Cobb’s angle, fusion rate, and neurologic recovery. Conclusions All the cases treated with different approach got satisfactory results. The determination of surgical approach should generally base on the condition of dislocation of facet joint ,reduction and injury of the disc.
[Key words] cervical spine; distraction-flexion injury; operation; anterior approach; posterior approach
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